Cholera in Haiti: a disaster waiting to happen

Nine months after the devastating 12 January 2010 earthquake, Haiti has once again been struck by misfortune. The cholera outbreak from last October has already claimed the lives of over 1,000 people, while there are nearly 17,000 hospitalised cases according to the Ministry of Public Health in Haiti. The United Nations (UN) estimates that up to 200,000 people could contract the disease which doubles the usual case fatality rate. Then, at the beginning of November, hurricane Tomas left 21 people dead and 6,610 homeless as it passed through a much beleaguered Haiti, exacerbating the cholera emergency.

Civil unrest has shaken Cap Haitien in recent days when clashes between UN peacekeepers and angry Haitians provoked the death of at least one man and resulted in a dozen more wounded. The UN Office for Coordination of Humanitarian Affairs (OCHA) reported that protests have slowed cholera prevention and treatment supplies from reaching the area, while the nearby World Food Programme (WFP) warehouse has been looted of 500 metric tonnes of food and subsequently burned. Many humanitarian organisations have been forced to halt their lifesaving assistance until the violence subsides.

However, it is hard to blame the Haitians for venting the full force of their anger and frustration. Regardless of whether the accusations against the Nepalese peacekeeping contingent for originating the cholera outbreak prove to be true, it is the lack of progress in the amelioration of the living conditions after the January earthquake that has been fuelling the frustration of the population. In spite of many success stories in both donor and implementing quarters the fact is that 1.3 million people are still living in tented camps in Port au Prince alone, with limited access to clean water, sufficient latrines or efficient waste management systems.

For many international observers and Haitians alike, it’s hard to comprehend how so much influx of aid in the country has apparently added up to so little impact. For instance, only 15% of transitional shelters have been constructed despite 86% of funding requirements being met. The implementation of early recovery activities has also been particularly slow. It is true, however, that only a small proportion of the US$5.3 billion pledged for reconstruction and long-term development at the Haiti Donor Conference last March has actually been committed and even less has reached the country. It is also true that nobody had predicted a cholera outbreak in Haiti, where the illness has never been registered since health surveillance systems were put in place in the 1960’s. Even the Centers for Disease Control and Prevention stated, back in March, that an outbreak of cholera was very unlikely to occur.

And yet I wonder whether a proper multi-sector nationwide assessment of needs, vulnerabilities and risks, from the very beginning of the crisis and throughout the emergency response operation, effectively linking with the recovery and reconstruction phase, would not have allowed a more coordinated and, ultimately, more effective planning and delivery of the aid. This approach might have prevented some of the response gaps that Haitians are currently forced to face.

For an analysis of how needs were assessed and how these assessments were used after the earthquake you can read our recent report: